Measuring Productivity in Rehabilitation, Part I

Editor's note: Part II will appear in the June 4 issue of ADVANCE and will explore the best uses for productivity studies and the formulae that should be used to assess efficiency in various care settings.

One of the most emotional issues for therapists is the subject of productivity/efficiency. While most facilities measure productivity in some manner, the formula used to determine therapist efficiency and to target efficiency levels vary widely. Therapists view the measurement of productivity as either an incentive or a threat.

When the business is patient care, employees become emotionally charged about measuring productivity. Evaluating efficiency does not include any quantification of quality of patient care. In addition, patient care has many variables that therapists cannot completely control. For example, do metalworkers have to obtain care plan changes from physicians? Do autoworkers need to speak with patients and family members to discuss issues? Do data entry staff help clients to the bathroom, while other clients are late for their appointments, or don't show up at all? Probably not.

But like it or not, delivering therapy services is a business. Businesses need to measure staff efficiency to make budget decisions including staffing and compensation. In essence, efficiency is a measure of the therapist's ability to deliver billable patient care while controlling non-billable time variables to the best extent possible.

In October 2000, a non-scientific productivity survey was published in print and/or online in this publication and its sister publications, ADVANCE for Occupational Therapy Practitioners and ADVANCE for Directors of Rehabilitation. In all, 284 readers voluntarily completed the survey.

Survey Results

The Table shows the results of the productivity survey. Several interesting trends emerged, as noted below.

Practice Settings. Nearly 17 percent of respondents indicated that they were employed in more than one setting. One therapist indicated that after working in five different positions concurrently for a total of 20 to 30 hours of pay per week without benefits, she opted for a significantly lower hourly wage job that offered full-time hours and benefits.

Payment sources. More than 80 percent of respondents receive payment from at least one government source (Medicare Part A or B or Medicaid).

Individual vs. Group Efficiency/Productivity Calculations. Despite the fact that most administrators in rehabilitation promote the concept of working as a team to give good patient care, most therapists (73 percent) indicated that their productivity was determined on an individual basis. Only 1 percent of respondents indicated that productivity is not measured in their facility.

Frequency of Efficiency Productivity Calculations. Many respondents indicated that efficiency is calculated at multiple intervals in their facility as the information moves up the chain of command. For example, therapists or supervisors calculate individual productivity daily, rehabilitation department directors convert the information into weekly statistics, and company executives look at monthly productivity.

Target Efficiency/Productivity. A target efficiency of 75 percent represented the median and mode for this question. Only 17 percent of respondents indicated that the target productivity standard in their facility was 70 percent or less. Surprisingly, 11 percent of respondents said that they are expected to be 100 percent efficient.

Consequences of Efficiency/Productivity Below Target Levels. In addition to the consequences listed in the table, the following consequences were given by respondents: 1) employee counseling and possible disciplinary action; 2) staff takes vacation/flex/comp time; 3) time off without pay (which can affect benefits); 4) staff works, but doesn't get paid; 5) employee positions are cut; 6) decreased annual salary raise; 7) increased inservices for rehabilitation and facility staff; 8) catch up on screening facility residents, and 9) brainstorming with rehabilitation staff.

Seemingly counterproductive measures taken against employees for substandard productivity included: 1) "lecture about finding patients to treat;" 2) "staff is reminded to stay 80 percent productive"; 3) "manager is counseled by area manager and threats are made to write up the manager or staff if productivity does not improve the next week; 4) announcement of the productivity statistics for all disciplines at the rehabilitation staff meeting.

Compensation for Achieving Specified Efficiency/Productivity. Only 6 percent of respondents indicated that therapists are given extra compensation for achieving a certain level of efficiency/productivity in their practice setting. This is an extreme turnaround from the period prior to the advent of the Prospective Payment System (PPS), when bonuses were fairly standard across the industry because therapists were in shorter supply and Medicare reimbursed the cost of therapy in long-term care.

Several therapists indicated that they believe the concept of compensating therapists for a certain level of productivity is unethical and facilitates fraud.

Long-term Care PPS. Sixty percent of respondents in skilled nursing facilities (SNFs) indicated that efficiency/productivity in their facility is based on actual minutes of care given, while 40 percent indicated that efficiency is based on minutes of care for which the facility is being reimbursed under the Resource Utilization Group (RUGs) level.

Summary

Most rehabilitation providers measure therapist productivity in some form, but the methods of determining productivity and the applications for statistics vary. This non-scientific efficiency/productivity study was used to determine the trends in measuring productivity in rehabilitation.

In Part II of this series, we will suggest productivity formulae for specific rehabilitation settings and further explore the topics of compensation for meeting target productivity, consequences for below-target performance, and methods to reduce swings in productivity levels. n

Danna Mullins and Pauline Watts are the co-founders of and principal lecturers for Encompass Education Inc., a rehabilitation education and consulting firm in Palm Harbor, FL. You may contact the authors at medicareadvisor@ encompasseducation.com. Look for their online Medicare advice column at www.advance forPT.com

Table. Efficiency/Productivity Survey Results

For totals >100 percent, respondents checked more than one answer.

For totals <100 percent, some respondents did not answer.

Question Percent

(Respondents = 284)

In what type of setting do you practice?

Hospital 38

SNF 49

Outpatient 31

Comprehensive Outpatient

Rehabilitation Facility (CORF) 2

Home Health 11

What are your payment sources?

Medicare Part A (PPS) 75

Medicare Part B 81

Medicaid 69

Health Maintenance Organization (HMO) 73

Other Private Insurance 76

Self Pay 55

Other 56

How is efficiency/productivity calculated?

Individual 73

Group 23

Do not measure productivity 1

How often is efficiency/productivity

calculated in your practice?

Daily 43

Weekly 19

Bi-weekly 8

Monthly 21

What is the target efficiency/productivity

for your practice?

50% 2

55% 2

60% 2

65% 3

70% 8

75% 34

80% 14

85% 12

90% 4

95% 1

100% 11

What happens if efficiency/productivity

drops below the target level?

Nothing 17

Saff is sent home 33

Staff is assigned other duties in the department 18

Staff is outsourced 8

Other 76

Are therapists given extra compensation

for achieving a certain target level?

Yes 6

No 86

If you work under the long-term care PPS

system, how do you determine

efficiency/productivity?

Based on actual care minutes 60

Based on minutes of care for which

you are being reimbursed 40

I am part of a corporation and have a 90% productivity rate to meet, now with threat of disciplinary action by October 31st if I do not comply. Is there a legal way to fight for the ethics of seeing patients as I deem fit, have time for teaching/overseeing COTAs, etc.? Class action suit by therapists for legalalities such as this?

Pattie Montgomery, OTR, SNF

September 19, 2012

Venice , FL

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